[The application of the multileaf collimator in radiotherapy: the dosimetric problems and the technical implications for its clinical use].
BACKGROUND
The multileaf collimator (MLC) now commercially available as an integral or optional retrofit component of linear accelerator heads, permitting to shield automatically irregular fields by computerized movements of multiple tungsten leaves. In the present paper we discuss the main characteristics of different MLC versions, MLC dosimetric drawbacks and the clinical fields where the MLC could he widely used.


METHODS
Since February, 1995, we have studied the dosimetric characteristics and clinical implications of a multileaf collimator of a Clinac 2100 C/D linear accelerator used to replace conventional low melting alloy blocks. The scalloping effect of isodoses and the effective penumbra produced by the multileaf collimator in an irregular field were analyzed accurately. Secondly, radiation leakage through tungsten leaves was measured and compared with the values of low melting alloy blocks. Finally, the MLC was extensively used in clinical practice for the radiotherapy of different tumors.


RESULTS
Different dosimetric steps were followed to obtain the monitor units/dose ratio. Our single MLC-shielded irregular fields measurements also showed several physical and dosimetric disadvantages related to wider effective penumbra than with conventional shielding when the angle between field margin and the normal to the direction of leaf travel is 45 degrees. In clinical practice, the MLC can be widely used for the conformal radiotherapy of pelvic and thoracic tumors. Conventional low melting alloy blocks should be replaced with MLC for radiotherapy of selected brain and head and neck cancers.


CONCLUSIONS
The current use of a multileaf collimator improves both the accuracy and the effectiveness of radiation therapy and reduces the time for every treatment dose, which potentially increases the number of patients treated every day. The multileaf collimator is presently an important technical tool either to replace conventional shielding for static conformational radiotherapy or to administer 3D-planned dynamic radiotherapy.
Corvò
R
R
Servizio di Oncologia Radioterapica, Istituto Nazionale per la Ricerca sul Cancro di Genova. corvo@hp380.ist.unige.it
Foppiano
F
F
Orsatti
M
M
Bisi
F
F
Ghiso
G
G
Martinelli
R
R
Valanzola
L
L
Vitale
V
V
D004867:Equipment Design; D005374:Filtration / Q000295:instrumentation; D006801:Humans; D009369:Neoplasms / Q000532:radiotherapy; D010315:Particle Accelerators / Q000295:instrumentation; D011878:Radiotherapy / Q000295:instrumentation* / Q000379:methods; D011879:Radiotherapy Dosage
Applicazione del collimatore multilamellare nella radioterapia: problematiche dosimetriche e implicazioni tecniche per l'uso clinico.